Polyarteritis nodosa medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
Line 4: Line 4:


==Overview==
==Overview==
Treatment involves medications to suppress the [[immune system]] such as [[prednisone]] and [[cyclophosphamide]]. Addition of [[immunosuppressants]] like [[cyclophosphamide]], [[methotrexate]], [[azathioprine]] to [[corticosteroid]] therapy has better prognosis. Patients with [[hepatitis B]] associated polyarteritis nodosa are treated with corticosteroid therapy, [[antiviral]] agents and [[plasma]] exchanges. Unlike [[hepatitis B]] associated PAN, [[Hepatitis C]] associated PAN is treated with [[Rituximab]] and corticosteoid therapy without antiviral agents, emphasizing the [[B cell]] targeted therapy. Mild cases of [[cutaneous]] polyarteritis nodosa are treated with [[nonsteroidal anti-inflammatory drugs]]. Severe cases are treated with corticosteroid and adjunctive therapy. [[Antibiotics]] are added to the treatment of patients with antecedent [[streptococcal infections]] or [[high ASO titer]].[[Intravenous immunoglobulin]] is suggested for treatment of corticosteroid therapy resistant cases, but the effect is transient. It is also used in the treatment of [[Parvovirus B19]] associated polyarteritis nodosa


==Medical Therapy==
==Medical Therapy==
Treatment involves medications to suppress the [[immune system]] such as [[prednisone]] and [[cyclophosphamide]]. Addition of [[immunosuppressants]] like [[cyclophosphamide]], [[methotrexate]], [[azathioprine]] to [[corticosteroid]] therapy has better prognosis.<ref name="pmid42314">{{cite journal |author=Leib ES, Restivo C, Paulus HE |title=Immunosuppressive and corticosteroid therapy of polyarteritis nodosa |journal=Am. J. Med. |volume=67 |issue=6 |pages=941–7 |year=1979 |month=December |pmid=42314 |doi= |url=}}</ref>.
* Treatment involves medications to suppress the [[immune system]] such as [[prednisone]] and [[cyclophosphamide]].  
Patients with [[hepatitis B]] associated polyarteritis nodosa are treated with corticosteroid therapy, [[antiviral]] agents and [[plasma]] exchanges.<ref name="pmid10214615">{{cite journal |author=Mouthon L |title=[Periarteritis nodosa induced by hepatitis B virus] |language=French |journal=Pathol. Biol. |volume=47 |issue=3 |pages=237–44 |year=1999 |month=March |pmid=10214615 |doi= |url=}}</ref>.<ref name="pmid11334492">{{cite journal |author=Trepo C, Guillevin L |title=Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis |journal=J. Autoimmun. |volume=16 |issue=3 |pages=269–74 |year=2001 |month=May |pmid=11334492 |doi=10.1006/jaut.2000.0502 |url=}}</ref>. Unlike [[hepatitis B]] associated PAN, [[Hepatitis C]] associated PAN is treated with [[Rituximab]] and corticosteoid therapy without antiviral agents, emphasizing the [[B cell]] targeted therapy.<ref name="pmid22089995">{{cite journal |author=Néel A, Masseau A, Hervier B, ''et al.'' |title=Life-threatening hepatitis C virus-associated polyarteritis nodosa successfully treated by rituximab |journal=J Clin Rheumatol |volume=17 |issue=8 |pages=439–41 |year=2011 |month=December |pmid=22089995 |doi=10.1097/RHU.0b013e31823a58d7 |url=}}</ref>
* Addition of [[immunosuppressants]] like [[cyclophosphamide]], [[methotrexate]], [[azathioprine]] to [[corticosteroid]] therapy has better prognosis.<ref name="pmid42314">{{cite journal |author=Leib ES, Restivo C, Paulus HE |title=Immunosuppressive and corticosteroid therapy of polyarteritis nodosa |journal=Am. J. Med. |volume=67 |issue=6 |pages=941–7 |year=1979 |month=December |pmid=42314 |doi= |url=}}</ref>.
 
* Patients with [[hepatitis B]] associated polyarteritis nodosa are treated with corticosteroid therapy, [[antiviral]] agents and [[plasma]] exchanges.<ref name="pmid10214615">{{cite journal |author=Mouthon L |title=[Periarteritis nodosa induced by hepatitis B virus] |language=French |journal=Pathol. Biol. |volume=47 |issue=3 |pages=237–44 |year=1999 |month=March |pmid=10214615 |doi= |url=}}</ref><ref name="pmid11334492">{{cite journal |author=Trepo C, Guillevin L |title=Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis |journal=J. Autoimmun. |volume=16 |issue=3 |pages=269–74 |year=2001 |month=May |pmid=11334492 |doi=10.1006/jaut.2000.0502 |url=}}</ref>
Mild cases of [[cutaneous]] polyarteritis nodosa are treated with [[nonsteroidal anti-inflammatory drugs]]<ref name="pmid20618492">{{cite journal |author=Morgan AJ, Schwartz RA |title=Cutaneous polyarteritis nodosa: a comprehensive review |journal=Int. J. Dermatol. |volume=49 |issue=7 |pages=750–6 |year=2010 |month=July |pmid=20618492 |doi=10.1111/j.1365-4632.2010.04522.x |url=}}</ref>. Severe cases are treated with corticosteroid and adjunctive therapy. [[Antibiotics]] are added to the treatment of patients with antecedent [[streptococcal infections]] or [[high ASO titer]].<ref name="pmid17544958">{{cite journal |author=Díaz-Pérez JL, De Lagrán ZM, Díaz-Ramón JL, Winkelmann RK |title=Cutaneous polyarteritis nodosa |journal=Semin Cutan Med Surg |volume=26 |issue=2 |pages=77–86 |year=2007 |month=June |pmid=17544958 |doi=10.1016/j.sder.2007.02.003 |url=}}</ref>.
* Unlike [[hepatitis B]] associated PAN, [[Hepatitis C]] associated PAN is treated with [[Rituximab]] and corticosteoid therapy without antiviral agents, emphasizing the [[B cell]] targeted therapy.<ref name="pmid22089995">{{cite journal |author=Néel A, Masseau A, Hervier B, ''et al.'' |title=Life-threatening hepatitis C virus-associated polyarteritis nodosa successfully treated by rituximab |journal=J Clin Rheumatol |volume=17 |issue=8 |pages=439–41 |year=2011 |month=December |pmid=22089995 |doi=10.1097/RHU.0b013e31823a58d7 |url=}}</ref>
 
* Mild cases of [[cutaneous]] polyarteritis nodosa are treated with [[nonsteroidal anti-inflammatory drugs]]<ref name="pmid20618492">{{cite journal |author=Morgan AJ, Schwartz RA |title=Cutaneous polyarteritis nodosa: a comprehensive review |journal=Int. J. Dermatol. |volume=49 |issue=7 |pages=750–6 |year=2010 |month=July |pmid=20618492 |doi=10.1111/j.1365-4632.2010.04522.x |url=}}</ref>.  
[[Intravenous immunoglobulin]] is suggested for treatment of corticosteroid therapy resistant cases, but the effect is transient.<ref name="pmid11586025">{{cite journal |author=Kroiss M, Hohenleutner U, Gruss C, Glaessl A, Landthaler M, Stolz W |title=Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa |journal=Dermatology (Basel) |volume=203 |issue=2 |pages=188–9 |year=2001 |pmid=11586025 |doi= |url=}}</ref><ref name="pmid17428360">{{cite journal |author=Balbir-Gurman A, Nahir AM, Braun-Moscovici Y |title=Intravenous immunoglobulins in polyarteritis nodosa restricted to the limbs: case reports and review of the literature |journal=Clin. Exp. Rheumatol. |volume=25 |issue=1 Suppl 44 |pages=S28–30 |year=2007 |pmid=17428360 |doi= |url=}}</ref>.It is also used in the treatment of [[Parvovirus B19]] associated polyarteritis nodosa.<ref name="pmid11357850">{{cite journal |author=Viguier M, Guillevin L, Laroche L |title=Treatment of parvovirus B19-associated polyarteritis nodosa with intravenous immune globulin |journal=N. Engl. J. Med. |volume=344 |issue=19 |pages=1481–2 |year=2001 |month=May |pmid=11357850 |doi=10.1056/NEJM200105103441919 |url=}}</ref>
* Severe cases are treated with corticosteroid and adjunctive therapy.  
* [[Antibiotics]] are added to the treatment of patients with antecedent [[streptococcal infections]] or [[high ASO titer]].<ref name="pmid17544958">{{cite journal |author=Díaz-Pérez JL, De Lagrán ZM, Díaz-Ramón JL, Winkelmann RK |title=Cutaneous polyarteritis nodosa |journal=Semin Cutan Med Surg |volume=26 |issue=2 |pages=77–86 |year=2007 |month=June |pmid=17544958 |doi=10.1016/j.sder.2007.02.003 |url=}}</ref>.
* [[Intravenous immunoglobulin]] is suggested for treatment of corticosteroid therapy resistant cases, but the effect is transient.<ref name="pmid11586025">{{cite journal |author=Kroiss M, Hohenleutner U, Gruss C, Glaessl A, Landthaler M, Stolz W |title=Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa |journal=Dermatology (Basel) |volume=203 |issue=2 |pages=188–9 |year=2001 |pmid=11586025 |doi= |url=}}</ref><ref name="pmid17428360">{{cite journal |author=Balbir-Gurman A, Nahir AM, Braun-Moscovici Y |title=Intravenous immunoglobulins in polyarteritis nodosa restricted to the limbs: case reports and review of the literature |journal=Clin. Exp. Rheumatol. |volume=25 |issue=1 Suppl 44 |pages=S28–30 |year=2007 |pmid=17428360 |doi= |url=}}</ref>
* It is also used in the treatment of [[Parvovirus B19]] associated polyarteritis nodosa.<ref name="pmid11357850">{{cite journal |author=Viguier M, Guillevin L, Laroche L |title=Treatment of parvovirus B19-associated polyarteritis nodosa with intravenous immune globulin |journal=N. Engl. J. Med. |volume=344 |issue=19 |pages=1481–2 |year=2001 |month=May |pmid=11357850 |doi=10.1056/NEJM200105103441919 |url=}}</ref>


==References==
==References==

Latest revision as of 03:45, 22 May 2018

Polyarteritis nodosa Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Polyarteritis nodosa from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiography

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Polyarteritis nodosa medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Polyarteritis nodosa medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Polyarteritis nodosa medical therapy

CDC on Polyarteritis nodosa medical therapy

Polyarteritis nodosa medical therapy in the news

Blogs on Polyarteritis nodosa medical therapy

Directions to Hospitals Treating Polyarteritis nodosa

Risk calculators and risk factors for Polyarteritis nodosa medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Haritha Machavarapu, M.B.B.S.

Overview

Treatment involves medications to suppress the immune system such as prednisone and cyclophosphamide. Addition of immunosuppressants like cyclophosphamide, methotrexate, azathioprine to corticosteroid therapy has better prognosis. Patients with hepatitis B associated polyarteritis nodosa are treated with corticosteroid therapy, antiviral agents and plasma exchanges. Unlike hepatitis B associated PAN, Hepatitis C associated PAN is treated with Rituximab and corticosteoid therapy without antiviral agents, emphasizing the B cell targeted therapy. Mild cases of cutaneous polyarteritis nodosa are treated with nonsteroidal anti-inflammatory drugs. Severe cases are treated with corticosteroid and adjunctive therapy. Antibiotics are added to the treatment of patients with antecedent streptococcal infections or high ASO titer.Intravenous immunoglobulin is suggested for treatment of corticosteroid therapy resistant cases, but the effect is transient. It is also used in the treatment of Parvovirus B19 associated polyarteritis nodosa

Medical Therapy

References

  1. ↑ Leib ES, Restivo C, Paulus HE (1979). "Immunosuppressive and corticosteroid therapy of polyarteritis nodosa". Am. J. Med. 67 (6): 941–7. PMID 42314. Unknown parameter |month= ignored (help)
  2. ↑ Mouthon L (1999). "[Periarteritis nodosa induced by hepatitis B virus]". Pathol. Biol. (in French). 47 (3): 237–44. PMID 10214615. Unknown parameter |month= ignored (help)
  3. ↑ Trepo C, Guillevin L (2001). "Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis". J. Autoimmun. 16 (3): 269–74. doi:10.1006/jaut.2000.0502. PMID 11334492. Unknown parameter |month= ignored (help)
  4. ↑ Néel A, Masseau A, Hervier B; et al. (2011). "Life-threatening hepatitis C virus-associated polyarteritis nodosa successfully treated by rituximab". J Clin Rheumatol. 17 (8): 439–41. doi:10.1097/RHU.0b013e31823a58d7. PMID 22089995. Unknown parameter |month= ignored (help)
  5. ↑ Morgan AJ, Schwartz RA (2010). "Cutaneous polyarteritis nodosa: a comprehensive review". Int. J. Dermatol. 49 (7): 750–6. doi:10.1111/j.1365-4632.2010.04522.x. PMID 20618492. Unknown parameter |month= ignored (help)
  6. ↑ Díaz-Pérez JL, De Lagrán ZM, Díaz-Ramón JL, Winkelmann RK (2007). "Cutaneous polyarteritis nodosa". Semin Cutan Med Surg. 26 (2): 77–86. doi:10.1016/j.sder.2007.02.003. PMID 17544958. Unknown parameter |month= ignored (help)
  7. ↑ Kroiss M, Hohenleutner U, Gruss C, Glaessl A, Landthaler M, Stolz W (2001). "Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa". Dermatology (Basel). 203 (2): 188–9. PMID 11586025.
  8. ↑ Balbir-Gurman A, Nahir AM, Braun-Moscovici Y (2007). "Intravenous immunoglobulins in polyarteritis nodosa restricted to the limbs: case reports and review of the literature". Clin. Exp. Rheumatol. 25 (1 Suppl 44): S28–30. PMID 17428360.
  9. ↑ Viguier M, Guillevin L, Laroche L (2001). "Treatment of parvovirus B19-associated polyarteritis nodosa with intravenous immune globulin". N. Engl. J. Med. 344 (19): 1481–2. doi:10.1056/NEJM200105103441919. PMID 11357850. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Polyarteritis_nodosa_medical_therapy&oldid=1472280"